Positive associations of bone mineral density with body mass index,physical activity,and blood triglyceride level in men over 70 years old: a TCVGHAGE study

It is known that osteoporosis decreases physical function in older males. However, the role of metabolic parameters and physical activity influencing older men's bone status remains unclear. Thus, this study was designed to evaluate calcaneus bone mass by ultrasonic screening and the associated physical and metabolic functions in older men. This was a cross-sectional study. Three hundred sixty-eight older men (average age, 78.8 years) living in a veterans' home were enrolled. We measured body height and weight, waist and hip circumference, body fat, lean body mass, blood pressure, 6-min walking distance, complete blood count, and blood biochemical profile. Broadband ultrasound attenuation (BUA) and T-score were recorded using Soundscan quantitative ultrasound over the right calcaneus. The range of calcaneus BUA was 27.3–134.0; T-score was from −4.78 to 3.43. Of the total participants, 36.4% were osteopenic (−2.5 < T-score < −1.0) and 16.3% were osteoporotic (T-score ≦ −2.5). BUA correlated with weight, body mass index (BMI), waist circumference, hip circumference, body fat, lean body mass, serum triglycerides, high-density lipoprotein-cholesterol, albumin, prealbumin, fasting and PC-2h blood insulin, red blood cell count, hemoglobin concentration, and 6-min walking distance. Multiple regression stepwise analysis revealed that only BMI, distance of 6-min walking, and blood triglyceride level were independently and positively associated with the values of BUA. Calcaneus bone mass is significantly and positively associated with BMI, blood triglycerides, and 6-min walking distance in older men.     

Weight and Body Mass Index at Menarche are Associated with Premenopausal Bone Mass

Adolescence is a critical time for skeletal growth and mineralization. Exposure to protective or detrimental factors during this period may influence peak bone mass attainment and subsequent development of osteoporosis. In order to evaluate the association of body size during adolescence with subsequent adult bone mass, we conducted a follow-up study of a community-based cohort of girls who participated in a growth and sexual maturation study 30 years ago. Data from the original study included age at menarche, height at menarche and weight at menarche. Follow-up evaluation of 119 subjects, now premenopausal women ages 40–45 years, included bone mineral density (BMD) measurements of the total body, lumbar spine, femoral neck, total hip, and ultradistal radius by dual-energy X-ray absorptiometry. After adjustment for current adult weight and other factors related to bone mass, weight at menarche was found to be positively associated with subsequent adult BMD. Similarly, body mass index (BMI) at menarche was positively associated with adult BMD. In contrast, age at menarche was not found to predict adult BMD. When the subjects were divided into quartiles based on their BMI at menarche, subjects in the lowest quartile of BMI at menarche had adult mean BMD that was 8–15% lower at the measured sites compared with subjects in the highest quartile of BMI at menarche. In conclusion, low body weight and low BMI at menarche appear to be significant predictors of reduced bone mass in healthy premenopausal women ages 40–45 years. Received: 15 August 2000 / Accepted: 2 January 2001     

Familial resemblance of radial bone mass between premenopausal mothers and their college-age daughters

Summary The influences of heredity and environmental factors on radial bone mass were evaluated in 84 premenopausal mothers with their biological daughters (ages 18–22). Mid- and distal radial bone mineral content (BMC) and density (BMD) were assessed using single-photon absorptiometry. As a group, the daughters (mean age 18.6 years) had 5–10% less bone mass at both the distal and midradial sites than their mothers (mean age 44.2 years). Familial resemblance estimates showed significant relationships between mothers and daughters for mid-and distal BMC and BMD after considering the influence of body mass index (BMI). Daughters with a maternal family history of osteoporosis had 6–7% lower but nonsignificant values of mid- (P=0.086) and distal BMC (P=0.075) compared to values of women with a negative family history, whereas mothers with a positive family history had 3–4% lower (NS) values of distal and mid-BMC compared to those of mothers with a negative family history after adjustment for BMI. Multiple regression analyses showed BMI to be the most important determinant of the bone values of the mothers, and both BMI and dietary calcium intake were found to be significant for the daughters. The findings of this study suggest that hereditary contributions from the mothers play an overwhelmingly critical role in the accrual of bone mass by their daughters by ages 18–22, but that environmental influences on bone consolidation during the premenopausal decades may be more important in promoting optimal (peak) bone mass and thereby may help to delay the postmenopausal onset of osteoporotic fractures.     

German Pediatric Reference Data for Quantitative Transverse Transmission Ultrasound of Finger Phalanges

Quantitative ultrasound (QUS) of the finger phalanges is a useful tool in the assessment of disease- or age-related deterioration of bone. For studying the impact of juvenile diseases or growth disorders affecting the skeleton, a reference database for QUS parameters is needed. The aim of this study was to establish a calibrated reference database of parameters of transverse ultrasound transmission through juvenile finger phalanges. A total of 1328 children (650 females, 678 males; ages 3–17 years) were measured in Heidelberg and Kiel in order to establish a German reference database. Highly significant gender-specific correlations (p<0.0001) were found between the QUS parameters amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT) versus age, body height and body mass index (BMI). For AD-SoS the correlation coefficients were R ²= 0.64 against age in males and R ²= 0.73 in females, R ²= 0.60 against body height in males and R ²= 0.68 in females, and R ²= 0.19 against BMI in males and R ²= 0.23 in females. For BTT the correlation coefficients were R ²= 0.74 against age in males and R ²= 0.79 in females, R ²= 0.75 against body height in males and R ²= 0.77 in females, and R ²= 0.32 against BMI in males and R ²= 0.35 in females. Age and height were the strongest determinants of QUS results. Gender-specific differences were observed in AD-SoS (significant for ages 11–14 years and for 150–170 cm body height) and in BTT (significant for ages 7 and 11–17 years and for 160–170 cm body height). Tables of QUS parameters versus age and height can serve as a basis for the evaluation of the impact of skeletal diseases or growth disorders on phalangeal QUS. Depending on the type of disease or growth disorder, measurement results can be compared with age- or height- specific reference data. In this way a simple and radiation-free assessment of juvenile skeletal disorders using quantitative ultrasound might be possible in the future. Received: 9 February 2001 / Accepted: 1 August 2001     

Age ≥50 Does Not Influence Outcome in Laparoscopic Gastric Banding

Background  Laparoscopic adjustable gastric banding is an accepted treatment for obesity. Age greater than 50 carries a theoretically increased risk from weight loss surgery and perhaps less clinical benefit in the long term. We compare results of gastric banding at age 50 and above with age below 50 in our unit. Methods  Between April 2003 and November 2007, 1,335 patients, mean weight 121.7 kg (range 73–268 kg), mean body mass index (BMI) 44.1 kg/m² (range 35–99), underwent gastric banding. Three hundred and twenty four patients had age ≥50. Band adjustments were usually carried out using fluoroscopy. Results  There was no statistically significant difference in the preoperative weights and BMIs for the two patient groups (age < 50: weight 120.7 ± 24.9, BMI 43.6 ± 7.3 kg/m²; age ≥ 50: weight 118 ± 23.7 kg, BMI 43.8 ± 7 kg/m²). Similarly, there was no statistically significant difference with regards to excess percent BMI loss in the two groups over 36 months (age < 50 = 49 ± 27.9; age ≥ 50 = 47.3 ± 35.1). There was no difference in the incidence of complications with patient age. Conclusion  These results demonstrate that, at age ≥50, this procedure is successful in producing weight loss and, at the same time, has a complication rate comparable to younger patients.     

Well-nourished cystic fibrosis patients have normal mineral density, but reduced cortical thickness at the forearm

Summary  Our goal was to assess mineral density and geometry of the cortex at the level of the forearm in adolescents and young adults with cystic fibrosis, using peripheral quantitative computed tomography. We found that density was normal, but cortical thickness significantly reduced, as well in males as in females. Introduction  Our goal was to measure bone mineral density as a volumetric density, as well as total cross-sectional area, cortical area and cortical thickness, using peripheral quantitative computed tomography (pQCT) at the forearm in adolescents and young adults with cystic fibrosis. We evaluated relationships between forearm bone measurements and body composition assessed using dual energy X-ray absorptiometry (DXA). Methods  An XCT 2000 pQCT (Stratec, Pforzheim, Germany) and a QDR 4500 A-upgraded to Discovery DXA device (Hologic, Waltham, MA, USA) were used. Results  Forty-eight patients (31 males,17 females, mean+/-SD 20+/5 years) were studied. Anthropometric features were: height 169+/- 10 cm, SDS 0.05+/-0.12, body mass index 19.8+/- 2.5 kg/m², SDS -0.56+/-0.14. Bone mineral density and total cross-sectional area of the forearm and body composition were normal, whereas cortical thickness was significantly reduced in males (mean Z-score – 1.22, p < 0.05), and in females (mean Z-score – 1.61, p < 0.05). Total body lean mass correlated more strongly with cortical thickness (r = 0.72, p < 0.001) than with total bone mineral density at the proximal radius (r = 0.39, p < 0.05). Conclusions  Adolescents and young adults with cystic fibrosis, presenting with only a slight degree of underweight, have at the radius a preserved bone mineral density but a reduced cortical thickness.     

Low body mass index and declining sex steroids explain most age-related bone loss in Brazilian men

Summary  Osteoporosis in men is underestimated, but our data point to an increasing prevalence rate in those over 70 years old with body mass index (BMI) <25 kg/m², bioavailable testosterone <2.7 nmol/L, bioavailable estradiol <40 pmol/L, and high bone turnover, defined in this study as serum carboxyterminal cross-linked telopeptide of type I collagen (ICTP) >4.3 μg/L. Introduction  The association of sex steroids and osteoporosis was evaluated in 104 men, aged 50–93 years old. Methods  Bone mineral density (BMD), bone turnover (ICTP), testosterone (T), and estradiol (E₂) were measured; free and bioavailable hormones (free testosterone index [FTI], BioT, free estradiol index [FEI], and BioE₂) were calculated from T, E₂, sex hormone-binding globulin (SHBG), and albumin. Nonparametric analysis and Poisson regression models were used. Results  Significant increases in SHBG and ICTP and decreases in femoral neck BMD, FTI, FEI, BioT, and BioE₂ were observed with each additional decade of age. Femoral neck BMD was inversely correlated with ICTP, and both were significantly associated with SHBG, FTI, BioT, FEI, and BioE. There was a direct and graded association between age and osteoporosis prevalence rate (OP PR; p = 0.028). Compared to participants less than 70 years old, the crude OP PR of those 80 years and older was 3.2 (95%CI = 1.4–7.3). Adjusting sequentially for BMI and bioavailable sex hormones attenuated the association between age and osteoporosis prevalence by 55% and 77%, respectively. Conclusion  Our data support the view that low BMI and declining sex steroids explain most of the association between aging, increased bone turnover, and osteoporosis in men.     

Asynchrony between the rates of standing height gain and bone mass accumulation during puberty

During puberty, the marked increases in both standing height and bone mass appear to be dissociated in time, the former occurring earlier than the latter. However, the age or pubertal stage at which this dissociation is maximal in girls as opposed to boys, and whether this dissociation is similar at all parts of the skeleton, are not clearly established. Standing height and bone mineral mass, as assessed by measuring areal bone mineral density (BMD), at the levels of the lumbar spine, femoral neck and midfemoral shaft, were measured in 98 females and 100 males between the ages of 9 and 19 years twice at a 1-year interval. In males, the greatest difference between height and BMD gains occurred in the 13–14 year age group and was more pronounced for the lumbar spine and femoral neck than for the midfemoral shaft. In females, the greatest difference was detectable at a younger age (11–12 year age group) and appeared to be of a lower magnitude than in males. In both genders, the maximal difference occurred during the period of peak height velocity, which corresponded to the pubertal stages P2-P3. Such a dissociation between the rates of statural growth and mineral mass accrual could define a state of relatively low bone mass and contribute to the higher incidence of fracture known to occur at the age and/or pubertal stage when this dissociation is maximal.     

Age-related changes of bone strength phenotypes: observational follow-up study of hand bone mineral density

Summary In a cross-sectional and follow-up study, we evaluated age-related changes of hand bone mineral density in both sexes using data obtained by digital radiographic densitometry in a large Chuvashian cohort. Objectives The aim of the study was to evaluate age-related changes of hand bone mineral density (BMD) in both sexes using data obtained by digital radiographic densitometry in a large Chuvashian cohort. Methods The data were gathered in 1994 (557 individuals) and 2002 (513 individuals). The latter sample included 260 individuals who were studied only during the second expedition and 253 individuals who had been previously investigated in 1994. Digital radiographic densitometry was employed to evaluate hand BMD. Statistical analyses included a maximum likelihood-based model-fitting technique. Results and conclusions Cross-sectional study: Since the third decade of life, men lost hand BMD at all ages, but it remained higher than in women at any age. The most parsimonious and best-fitting piecewise linear models of age-related changes of hand BMD had higher prediction values in females than in males (R ² = 0.48–0.58 vs R ² = 0.20–0.29, correspondingly). The compact BMD is more sensitive to age changes than the total BMD in both sexes. Longitudinal study: Hand BMD loss was higher in males than in females aged 30–59, but afterwards this trend reversed. The highest loss in both sexes was in ages 50–59.     

Weight and body mass index predict bone mineral density and fractures in women aged 40 to 59 years

Summary  Weight and body mass index are associated with low bone mineral density and fractures in older women. This retrospective cohort study confirms a similar relationship in women aged 40 to 59 years. Introduction  Risk factors for the prediction of osteoporosis and fractures have been less thoroughly studied in younger women. We evaluated the associations between weight, body mass index (BMI), the Osteoporosis Self-Assessment Tool (OST), bone mineral density (BMD) and fracture risk in women aged 40 to 59 years. Methods  Using administrative health management databases, we conducted a retrospective cohort study in 8,254 women aged 40–59 years who had baseline BMD testing. Linear regression and Cox proportional multivariate models were created to examine the associations with weight, BMI, OST, BMD, and subsequent fractures throughout a 3.3-year follow-up. Results  Body weight, BMI, and OST had a similar overall performance in their ability to classify women with femoral neck T-score ≤ −2.5. Throughout 27,256 person years of observation, 225 women experienced one or more fractures. After adjustment for age, prevalent fractures, and use of corticosteroids, each standard deviation decrease in weight was associated with a 19% increase in the risk of incident fracture (95% CI: 1.01–1.35). Femoral neck BMD and the presence of prevalent fractures were also associated with the risk of incident fractures. Conclusions  Low weight and BMI predict osteoporosis and are associated with increased fracture risk in younger women. The negative impact of low body weight on bone health should be more widely recognized. On behalf of the Manitoba Bone Density Program.     

The relationship between body composition and bone mineral content: threshold effects in a racially and ethnically diverse group of men

Summary We examined BMC and body composition in 1,209 black, Hispanic, and white men. Weight, BMI, waist circumference, and fat mass were associated with BMC only up to certain thresholds, whereas lean mass exhibited more consistent associations. The protective influence of increased weight appears to be driven by lean mass. Introduction Reduced body size is associated with decreased bone mass and increased fracture risk, but associations in men and racially/ethnically diverse populations remain understudied. We examined bone mineral content (BMC) at the hip, spine, and forearm as a function of body weight, body mass index (BMI), waist circumference, fat mass (FM), and nonbone lean mass (LM). Methods The design was cross-sectional; 363 non-Hispanic black, 397 Hispanic, and 449 non-Hispanic white residents of greater Boston participated (N = 1,209, ages 30–79 y). BMC, LM, and FM were measured by DXA. Multiple linear regression was used to describe associations. Results Weight, BMI, waist circumference, and FM were associated with BMC only up to certain thresholds. LM, by contrast, displayed strong and consistent associations; in multivariate models, femoral neck BMC exhibited a 13% increase per 10 kg cross-sectional increase in LM. In models controlling for LM, positive associations between BMC and other body composition measures were eliminated. Results did not vary by race/ethnicity. Conclusions The protective effect of increased body size in maintaining bone mass is likely due to the influence of lean tissue. These results suggest that maintenance of lean mass is the most promising strategy in maintaining bone health with advancing age.     

Age,gender, and body mass effects on quantitative trait loci for bone mineral density: the Framingham Study

A genome-wide scan was performed in participants from the Framingham Osteoporosis Study (1557 members of 330 mostly Caucasian pedigrees), with 401 microsatellite markers spaced on average at 10 cM. Bone mineral density (BMD) was measured at the femoral neck, trochanter, Ward's area, and lumbar spine with DXA. Our recent study (J Bone Mines Res 17 (2002), 1718) reported a number of regions with suggestive linkage to possible quantitative trait loci (QTL). The current study estimates the heterogeneity of linkage in these regions in subsamples of our pedigrees, stratified on the known biological contributors to bone mass of sex, age, and body mass index (BMI). The pedigree sample was stratified into three sets of subgroups by sex [males (age range 35- 96 years), females (29-91 years)], by age [60 or younger (29-60 years) and older than 60 (61-96 years)], and by BMI [stratified into low or high BMI, by median cut-off 27.7 in males (BMI range 17-53) and 25.8 in females (14-54)]. Heritability estimates of BMD (adjusted for age, anthropometry, nutrition, physical activity, and, in females, estrogen use) in subsamples ranged from 0.47 to 0.69. Two-point and multipoint variance component linkage analyses of BMD (using SOLAR) in subsamples supported findings of previously reported suggestive linkage results in the total sample on 8q24.13 and 14q31 (LODs>2.0). However, heterogeneity of linkage was observed on 6p21.2 and 21qter, where findings in the total sample were not supported by subsamples. On the other hand, subsample-specific maxima were found, on 4q34.1 (males), 9q22-9q31 (younger), 16p13.2 (high BMI), and 17p13.3 (older), which were not reflected by the total sample results. In conclusion, heterogeneity of QTL effects was revealed in pedigree members stratified by sex, age, and BMI; in some instances new loci were identified in subgroups. These findings may suggest that effects of genes on the determination of BMD differ between men and women, younger and older, and lean and obese adults. Evaluation of family members stratified in homogeneous groups may be warranted in genetic studies of bone mass.     

Mineral Metabolism in Obese Patients Following Vertical Banded Gastroplasty

Background Bone disease has been described in patients after surgical treatment for obesity, but few studies have dealt with the impact of vertical banded gastroplasty on mineral metabolism. We have examined bone mineral metabolism in morbidly obese patients before and after 3 months after vertical banded gastroplasty without vitamin D supplementation. Methods Sixteen morbidly obese patients (14 women, 2 men) with a mean (±SD) age of 38 ± 9 years and a body mass index (BMI) of 47.1 ± 8.1 kg/m² were studied. No vitamin D supplementation was given. Body weight, fat mass, calcium, 25OHD, iPTH, bone remodeling markers, and leptin levels were measured at baseline and after weight loss. Results Mean weight loss was 28 ± 11 kg; BMI and body fat mass decreased by 20 and 35%, respectively. Bone resorption markers and albumin-corrected serum calcium increased after operation, whereas iPTH fell. Serum 25OHD levels rose. Leptin levels decreased. Serum iPTH was positively correlated with weight, BMI, and fat mass before operation (p < 0.05), and its decline after weight reduction was negatively associated with the increase in bone resorption markers (p < 0.01). Leptin concentration was correlated with BMI and body fat mass (p < 0.05) both before and after surgery. Conclusions Weight reduction obtained in morbidly obese subjects 3 months after vertical banded gastroplasty increases bone turnover markers and decreases PTH secretion. Serum 25OHD levels rose. Therefore, no reasons for a metabolic bone disease related to hypovitaminosis D were readily apparent. However, an increase in bone turnover, which is generally regarded as a potential risk factor for osteoporosis, was observed. Further work is needed to clarify the importance of this turnover increase in the long run.     

A Randomized, Double-Blind, Placebo-Controlled Trial of Intravenous Zoledronic Acid in the Treatment of Thalassemia-Associated Osteopenia

Beta-thalassaemia major is associated with low bone mass and fractures. We conducted a 2 year randomized controlled trial of zoledronic acid 4 mg administered intravenously every 3 months or placebo in the treatment of β-thalassaemia-associated osteopenla. We recruited 23 subjects from 2 university hospitals with a T score of less than −1.0 at either the lumbar spine or hip, and 23 subjects completed the study (17 M, 6 F). Treatment groups did not differ significantly with respect to bone mineral density (BMD), age, height, weight and body mass index (BMI) at baseline. BMD was assessed at baseline, 12 months and 24 months by dual-energy X-ray absorptiometry (DXA) at the lumbar spine, femoral reek, total hip and total body. After two years average lumbar spine BMD was 8.9% greater (95%CI 2.3–15.5%, P = 0.011), average femoral neck BMD was 9.1% greater (95%CI 5.5–12.7%, P < 0.0001), average total hip BMD was 9.6% greater (95%CI 6.5–12.6%, P < 0.0001) and average total body BMD was 4.7% greater (95%CI 2.7–6.8%, P < 0.0001) in the treated group compared to placebo. The absolute change in BMD from baseline to 2 years and the annualized rate of change of BMD was significantly greater in treated patients at all four sites. Age, gender, height, weight and BMI did not interact with the effect of treatment and so unadjusted data was used. The serum total ALP decreased 45% by 12 months (P = 0.004) and urinary deoxypyridinoline/creatinine ratio decreased 47% by 3 months (NS). We conclude that zoledronic acid (4 mg i.v. 3 monthly) suppresses bone turnover and increases BMD in β-thalassaemia-associated osteopenia.     

Gender Differences in Early Outcomes Following Hand-Assisted Laparoscopic Roux-en-Y Gastric Bypass Surgery

Background Male gender has been associated with a higher morbidity and mortality rate after bariatric surgery including laparoscopic and open procedures. This study focused on hand-assisted laparoscopic Roux-en-Y gastric bypass and morbidity and mortality among genders. Methods Hand-assisted laparoscopic Roux-en-Y gastric bypass operations (N = 319) were evaluated from October 2003 to March 2006. Comparison between males (N = 54) and females (N = 265) were conducted using t test or Fishers exact test and chi-square analysis. Results Patients’ average age was 42.3 ± 10.3 and the average body mass index (BMI) was 49.2 ± 7.9. There was no significant difference between males and females in age or BMI. Males had a significantly greater average weight than females (p < 0.001) and were significantly more likely to experience sleep apnea (p = 0.006) and have heart disease (p = 0.017). For operative risk factors, males had a significantly longer anesthesia time (p = 0.003), operative time (p = 0.027), and length of roux limb (p = 0.038). At 6 and 12 months postsurgery, there was no significant difference between males and females with complications. Although BMI did not differ significantly, males continued to weigh significantly more than females and lost significantly more pounds than did females at both 6 and 12 months postoperation. Conclusion Given their larger size and tendency to accumulate fat in the abdominal compartment that increases the technical difficulty of the procedure, males are historically associated with a higher morbidity and mortality following bariatric surgery. Based on the current study, however, there is no difference in outcome among genders following hand-assisted laparoscopic Roux-en-Y gastric bypass.     

High bone mineral density is associated with high body mass index

Summary  High BMD is an infrequent finding. In this retrospective cohort study of women 50 years and older, we documented a strong association between high BMD and high BMI. Introduction  High bone mineral density (BMD) has been associated with genetic disorders and a variety of dietary, endocrine, metabolic, infectious and neoplastic diseases that in many cases warrant medical attention. Since body mass index (BMI) is closely correlated with BMD, we sought to explore the relationship between these two parameters in older women. Methods  We conducted a retrospective clinical cohort study of 16,500 women 50 years and older who underwent baseline BMD testing between May 1998 and October 2002. Mean T-scores and Z-scores, and the proportions of women with high BMD (T-score +2.5 or greater, Z-score +2.0 or greater), were assessed according to BMI category. Results  Higher BMI category was associated with higher mean T-scores and Z-scores at all sites (P < 0.001). The proportion of women with high BMD increased with each BMI category (P for trend <0.05). In women with a lumbar spine T-score of +2.5 or more, 43.5% were obese with BMI > 30 kg/m² (55.6% for the femoral neck and 73.1% for the total hip). For women with a lumbar spine Z-score of +2.0 or more, 37.2% were obese (42.0% for the femoral neck and 50.9% for the total hip). There was no evidence of a paradoxical increase in fracture rates in women with high BMD. Conclusions  High BMD is closely associated with elevated BMI in women. This should be taken into consideration prior to initiating extensive investigations for rare pathologies. This study was supported in part by an unrestricted educational grant from the CHAR/GE Healthcare Development Awards Programme.     

Anthropometric,Bone Age,and Bone Mineral Density Changes after a Family-Based Treatment for Obese Children

Our objective was to identify anthropometric, bone age, and bone mineral density (BMD) changes after a family-based treatment program for obese children. We conducted a longitudinal prospective study of 50 obese children (body mass index percentage [BMI%] ≥120%) aged 9.12 ± 1.72 years (range 6–13) at baseline. A family-based treatment program, based on inadequate feeding style with progressive modification, aerobic physical exercise increase, active parental involvement, and the use of behavioural strategies (contracting, self-monitoring, social reinforcement), was developed during a 12-month period. Anthropometric data, lumbar spine (L2-L4) BMD by dual-energy X-ray absorptiometry, bone age (BA), bone age to chronological age ratio (BA/CA), and predicted adult height (PAH) were determined at baseline and 12 months. The statistical method used was analysis of variance and the paired Student t-test. Mean BMI standard deviation score (SDS) loss was –0.61 ± 0.76 and BMI% loss was –5.17 ± 9.73%. Height SDS significantly decreased, BA/CA ratio also decreased significantly, and PAH change was not significant. Lumbar spine BMD SDS and BMD% did not significantly change. A family-based treatment program was effective in obese children by reducing by 5% the BMI in 1 year and increasing the activity level. Treatment reduced growth velocity and delayed bone maturation rate without affecting PAH, reflecting a situation of previous early maturation. The treatment did not modify gaining bone mass.     

Impact of increased overweight on the projected prevalence of osteoporosis in older women

Introduction Overweight is increasing worldwide, but particularly in the United States of America. Higher body weight is associated with higher bone density, so our goal was to estimate whether the higher prevalence of overweight is likely to reduce osteoporosis among older women. Methods We calculated the prevalence of osteoporosis by weight status in older women using data from the third National Health and Nutrition Examination Survey (NHANES III, 1988–94). We defined overweight as a body mass index (BMI) ≥25 and osteoporosis as a femur neck bone mineral density (BMD) value 2.5 standard deviations or more below the mean of that of young women. To estimate the expected prevalence of osteoporosis, we applied the prevalence of osteoporosis by weight status from NHANES III to the corresponding weight status prevalence from NHANES 1999–2002. Results Of older women in NHANES 1999–2002, 68% were overweight compared to 62% in NHANES III. Overweight status was significantly related to osteoporosis prevalence (P < 0.001). However, the expected prevalence of osteoporosis in NHANES 1999–2002 was only slightly lower than that seen in NHANES III (16.8% vs 18.1%, respectively). Conclusions The increasing prevalence of overweight among older US women appears unlikely to be accompanied by a significant reduction in osteoporosis.     

Muscle mass deficits are associated with bone mineral density in men with idiopathic vertebral fracture

Introduction and hypothesis The causes of idiopathic vertebral fractures (IVF) in men are poorly understood. We hypothesised that in IVF, areal bone mineral density (aBMD) deficits would be associated with reduced muscle mass. Methods In this case-control study, 48 men (61.5 ± 12.1 years old) presenting with symptomatic IVF were compared with 48 healthy controls matched for age (±5 years) and stature (±5 cm). The aBMD and soft-tissue body composition were determined by dual energy X-ray absorptiometry (DXA). Muscle mass was defined as the ratio of appendicular lean mass to the square of height (ALMI). Sex hormones, IGF-I and its binding protein IGFBP-3 were measured by immunoassay. Results ALMI was significantly lower in IVF patients (8.27 ± 0.90 vs 8.65 ± 0.88 kg/m², t = 2.193, df = 47, P = 0.033 by paired sample t-test). Hierarchical regression analysis revealed that for IVF patients, ALMI explained the greatest proportion of variance in BMD at the lumbar spine, femoral neck and total hip (R ² _change = 16.4–22.7%, P = 0.012–0.002) and only IGFBP-3 explained variance in ALMI (R ² _change = 19.9%, P = 0.006). Conclusions In men with IVF, ALMI was reduced and associated with IGFBP-3. ALMI was identified as a novel factor that explained a greater proportion of variance in BMD than either fat mass or serum biochemistry. Electronic Supplementary Material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Telomere length in leukocytes correlates with bone mineral density and is shorter in women with osteoporosis

Summary Telomere length decreases with age and is associated with osteoblast senescence. In 2,150 unselected women, leukocyte telomere length was significantly correlated with bone mineral density. Clinical osteoporosis was associated with shorter telomeres, suggesting that telomere length can be used as a marker of bone aging. Introduction The length of telomeres in proliferative cells diminishes with age. Telomere shortening and telomerase activity have been linked to in vitro osteoblast senescence and to increased secretion of pro-inflammatory cytokines. We explored whether bone mineral density correlates with telomere length in leukocytes. Materials and methods The relationship between leukocyte telomere length, bone mineral density (BMD) and osteoporosis (as defined by the World Health Organization) was examined in a cohort of 2,150 women from a population-based twin cohort aged 18–79. Results After adjusting for age, body mass index, menopausal status, smoking, hormone replacement therapy status, telomere length was positively correlated with BMD of the spine (p < 0.005), forearm (p < 0.013), but not the femoral neck (p < 0.06). Longer telomeres were associated with reduced the risk of clinical OP at two or more sites (odds ratio = 0.594 95% CI 0.42–0.84 p < 0.003) and in women over the age of 50, clinical osteoporosis was associated with 117 bp shorter telomere length (p < 0.02) equivalent to 5.2 years of telomeric aging. Conclusions Shortened leukocyte telomere length is independently associated with a decrease in BMD and the presence of osteoporosis in women. Our data provide evidence that leukocyte telomere length could be a marker of biological aging of bone.